Background: This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in Sao Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. Methods: This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection CLABSI and Ventilator-Associated Pneumonia - VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 - December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. Results: 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (<= 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. Conclusions: HAI increased during COVID-19. The microorganisms' susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.

Background: Since its first report in the country in 2013, NDM-producing Enterobacterales have been identified in all the Brazilian administrative regions. In this study, we characterized by antimicrobial susceptibility testing and by molecular typing a large collection of NDM-producing Klebsiella isolates from different hospitals in Brazil, mainly from the state of Sao Paulo, over the last decade. Methods: Bacterial isolates positive for bla_NDM-genes were identified by MALDI-TOF MS and submitted to antimicrobial susceptibility testing by disk diffusion or broth microdilution (for polymyxin B). All isolates were submitted to pulsed-field gel electrophoresis, and isolates belonging to different clusters were submitted to whole genome sequencing by Illumina technology and downstream analysis. Mating out assays were performed by conjugation, plasmid sizes were determined by S1-PFGE, and plasmid content was investigated by hybrid assembly after MinIon long reads sequencing. Results: A total of 135 NDM-producing Klebsiella were identified, distributed into 107 different pulsotypes; polymyxin B was the only antimicrobial with high activity against 88.9% of the isolates. Fifty-four isolates presenting diversified pulsotypes were distributed in the species K. pneumoniae (70%), K. quasipneumoniae (20%), K. variicola (6%), K. michiganensis (a K. oxytoca Complex species, 2%), and K. aerogenes (2%); bla_NDM-1 was the most frequent allele (43/54, 80%). There was a predominance of Clonal Group 258 (ST11 and ST340) encompassing 35% of K. pneumoniae isolates, but another thirty-one different sequence types (ST) were identified, including three described in this study (ST6244 and ST6245 for K. pneumoniae, and ST418 for K. michiganensis). The bla_NDM-1 and bla_NDM-7 were found to be located into IncF and IncX3 type transferable plasmids, respectively. Conclusions: Both clonal (mainly driven by CG258) and non-clonal expansion of NDM-producing Klebsiella have been occurring in Brazil in different species and clones, associated with different plasmids, since 2013.

Public health faces daily challenges due to increasing reports of pathogenic microorganisms with new antimicrobial resistance. Klebsiella michiganensis, an emerging pathogen, poses difficulty in its identification using conventional techniques. This study presents the first documented case of NDM-1-producing K. michiganensis in Brazil, identified as the new ST418. Initially, the isolate from a tracheal secretion was misidentified as K. oxytoca. However, accurate identification was achieved through ANI analyses. Whole-genome sequencing was conducted to characterize the genetic context of the resistance genes, to identify virulence factors, and to construct a phylogenetic tree. The bla_NDM-1 gene was found to be harbored on an IncFIB plasmid approximately 112 kb in length, which was transferable in conjugation assays. The detection of carbapenem resistance genes in this species highlights the importance of public health vigilance, as it may serve as a reservoir and disseminator of significant resistance genes.

SumaryObjectivesClostridioides difficile infection (CDI) is a major healthcare-associated infection, emphasizing the urgent need for preventive measures to reduce its incidence and improve healthcare quality. This study aimed to evaluate the structure and approach of Infection Prevention and Control (IPC) Committee regarding CDI management in hospitals across Brazil.Study designA cross-sectional survey was conducted using a self-administered questionnaire targeting infectious disease specialists and IPC Committee members. The survey focused on institutional practices related to CDI, including diagnosis, treatment guidance for CDI and presence of Antimicrobial Stewardship Programs (ASPs).MethodsData were collected through Google Forms and accessed by e-mail. Statistical analyses included Pearson's chi-square and Fisher's exact tests.Results281 hospitals participated, mostly private institutions (n=153; 54.5%), with 79.7% (n=224) located in São Paulo state. ELISA for Toxins A and B was the most frequent diagnostic method (n=117; 51.3%), followed by simultaneous (n = 54; 23.7%) and sequential tests (n = 24; 10.5%). For non-severe CDI, oral metronidazole was the preferred treatment (n =189; 67.5%), succeeded by oral vancomycin (n=69; 24.6%), while 7.1% (n = 20) of hospitals lacked institutional recommendations. The presence of an ASP, more common in high-complexity hospitals (p=0.013), was associated with greater availability of therapeutic guidelines (p < 0.001) and laboratory CDI diagnosis (p = 0.026).ConclusionThe organizations and management of IPC Committees in Brazilian hospitals face challenges in controlling CDI. The absence of diagnostic resources may hinder effective CDI control. ASP presence was associated with laboratory diagnosis availability and institutional treatment recommendations.